Some upheld, recommendations

Summary

Mrs C and her neighbour live at opposite ends of a row of four cottages. The two middle properties are owned by a third party (Mr M) who operated one of the properties as a shop. Mr M applied for and was granted planning permission to extend the shop into the second of his properties. Mrs C and her neighbour then complained to the council about an ongoing issue with noise from internal and external air cooling units connected to the shop. Mrs C considered that planning consent should have been sought and required for the units.

We found that Mr M did not include details of the cooling units in his planning application and that the council could not, therefore, take a view that planning permission was required before consent for the shop development was granted. Following Mrs C's complaint, the council decided that planning permission was required for one of the units. However, they took no enforcement action to regularise the situation, as environmental services were still investigating complaints about the noise. We found it reasonable for the council to delay taking enforcement action on the planning merits of the units pending the outcome of the noise investigation, as this could have resulted in the units being changed or moved. We were also satisfied with the council's consideration of complaints about soundproofing between the cottages, but we were critical of a lack of record-keeping showing the reasoning behind their decisions.

Although we acknowledged that the process took some time, we found that there was clear evidence of continuous activity by the council in relation to Mrs C's complaints about noise over a period of one and a half years. We also found that they adhered to their own policies by taking a preventative approach and by supporting Mr M in trying to resolve the issue. We found that due to the nature of the work required, this process can, and often does, take a considerable period of time. Mrs C complained that the council did not act on its findings and progress to legal action but we found that the council acted on its findings throughout and moved to take legal action at an appropriate stage. Had they taken legal action sooner, they would have been in breach of their own policies and of government guidance in relation to the preferred preventative approach to resolving such issues.

We upheld Mrs C's final complaint that the council did not provide updates to her when they had agreed to do so. Although we did not consider it realistic for the council to report back on every single event, we found that when they agreed to provide an update and did not, this was not in keeping with their customer service strategy. The strategy says that they will keep their commitments to customers when providing services and tell them about the progress of the service requested.

Recommendations

We recommended that the council:

• consider, when dealing with a complex service request, allocating a single point of contact to the complainant and agreeing at an early stage how and when updates and communications will be provided; and
• consider issuing a memo to all relevant staff to ensure they are aware that an abatement notice will become time barred from proceeding to legal action within six months of the date of first issue.
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Summary

Ms C complained about the council's processing of two planning applications in respect of the demolition of a property in a conservation area and the erection of a new home. Two applications were required due to separate consent being required under conservation area consent requirements.

We did not uphold her complaint that the processing was incorrect as the second application did not include information required by council guidance, because our investigation found the application did in fact include this information. We noted however that in their response, the council had not made this clear to Ms C.

We did uphold Ms C's complaint that the council did not respond properly to her complaints. That there were lengthy unexplained delays, and the final response failed to address an additional concern Ms C had raised. We also noted it was not reasonable that the report about the first application was not available on the council's online portal until eight days after the application was granted. We recognised this prevented members of the public having faith in the process.

We also noted some issues in relation to the way the two applications were handled; for example, the applications could have been handled alongside each other, as the process as it stood suggested one had pre-empted the other. In addition, there was some key wording missed out in error in the first application, which could potentially have been misleading and suggested the second application would not be required. We drew this to the council's attention and made three recommendations.

Recommendations

We recommended that the council:

• provide Ms C with a full apology for not responding to her complaint timeously and for not fully addressing the concerns she raised;
• provide the Ombudsman with evidence to demonstrate that the council's internal complaints procedure is being complied with, including evidence that complainants are contacted to seek agreement for further time to respond if required; and
• review and improve procedures for planning applications which require separate conservation area applications to ensure a pragmatic approach and provide evidence of this review to the Ombudsman.

Summary

Mr and Mrs C complained about the council's handling of an application for planning consent for a two storey extension to the house next door. They alleged that the council failed to handle the planning application appropriately. They said that the planning officer wrongly calculated the overall size of the house next door in assessing the extension; their objections were not appropriately taken into account, particularly with regard to overshadowing and light restriction to their windows; granting consent with a specific finish could only be achieved by the neighbours accessing their property; and the council failed to take into account the future difficulty of maintaining Mr and Mrs C's property.

As part of our investigation we obtained independent advice from one of our planning advisers. We found that an error had indeed been made in failing to consider the earliest of several previous extensions to the property next door, which resulted in the wrong baseline being used to compare percentages. This did not, however, in the view of the planning adviser imply that consent had wrongly been granted. In general, appropriate consideration had been given to the council's supplementary planning guidance notes. We did not uphold the three other complaints. We noted that the applicant, as he was entitled to do, applied for consent to construct the extension up to the boundary but the council had, in granting consent, omitted to include a condition relating to a particular finish. We, therefore, made a recommendation about this.

Recommendations

We recommended that the council:

• consider the error which occurred in this instance with a view to ensuring that in future the full relevant planning history of a property is assessed in respect of planning applications for domestic extension; and
• explore the reasons why, when the local plan guidance generally requires that the materials and finish of an extension match the existing house, such a condition was not applied to the consent on the application.
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Summary

Mr C, who is a solicitor, complained on behalf of his clients about the way in which the council dealt with a neighbouring farmer's planning review application. He said that his clients were not given enough time to make their representations against the review, nor were their views, once made, taken into account. He also said that the review process was not adequately carried out nor were his clients' interests sufficiently protected . Finally, he complained that they were not told the outcome of the review which, in effect, deprived them of the right of appeal to the courts.

We investigated the complaint and obtained specialist planning advice. Our investigation found that most of the process was carried out in terms of the legislation, and we did not uphold three of the complaints. However, we found that although the council acted in accordance with the appropriate legislation with regard to notification they had not provided information on their website, as they said they had. On balance we decided to uphold the complaint about notification of the review. They also failed to officially tell Mr C's clients of the outcome of the review, which meant that his clients missed their opportunity to appeal, and we also upheld his complaint about this.

Recommendations

We recommended that the council:

• ensure that information on their website concerning local reviews is made clear;
• demonstrate that processes have been put in place to prevent a recurrence of the situation; and
• apologise formally to Mr C's clients.
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Summary

Mr C has complex needs and requires long-term care and specialist input. He has severe dementia, with limited capacity to judge distance or to understand and participate in therapies, and his wife (Mrs C) has welfare power of attorney for him. Mr C can move about, but is at particular risk of falling. In November 2007 Mr C was admitted to a continuing care ward, where he remains a patient. Mrs C made a number of complaints about aspects of the care and treatment that her husband has received. These included the actions the board took to address Mr C's condition in February 2011, medication, observation and monitoring, staffing levels, carer communication, charting and record-keeping, the standard of bathroom facilities and complaints handling.

Our investigation included taking independent advice from two of our medical advisers - one in mental health and one a GP. We took account of this advice as well as evidence from Mrs C and the board. Mrs C said that in February 2011 her husband became very unwell and staff failed to take reasonable measures to bring his temperature down and call a doctor within a reasonable time. Our investigation found that staff took appropriate action when Mr C became unwell and that their interventions overall were reasonable. In relation to the drug regime and administration, however, although we found that the principal contributing factor to Mr C's falls was most likely to have been involuntary muscle twitching, we also found that there were significant failings. These included the discontinuation of an antidepressant for three weeks; the timing of medication; and failure to ensure Mr C received prescribed medication when off the ward. We also found that the board failed to administer flu vaccinations to Mr C, either within a reasonable time or at all, placing his physical health at risk.

Mrs C also said that the board failed to ensure that Mr C was sufficiently hydrated (had enough fluids). We found that throughout the period Mr C was well hydrated and had effective liver and kidney function, but that there were inconsistencies in recording and monitoring his fluid balances. We also found that the board failed to properly assess Mr C's falls risk or properly record or implement a fall prevention care plan.

Mr C was sedated because he wandered at night due to agitation, and Mrs C felt that this could have been managed without resorting to sedation if there were more staff. We did not uphold this complaint as we found that, while it was difficult to reach a definitive conclusion on whether staffing levels were reasonable, staff used sedating medication as a last resort and then only rarely. In relation to Mrs C's complaint about bathroom facilities, the evidence available suggested that the ward is cleaned to an acceptable standard and that any problems are addressed within a reasonable time.

Mrs C said that staff communication about assessment of her husband's capacity and administration of sedative drugs was inadequate and she was also concerned that a 'do not attempt to resuscitate' certificate (DNAR - showing that a doctor is not required to resuscitate the patient if their heart stops) was signed by medical staff without her input. We upheld this complaint as we found that communication with Mrs C was not of a reasonable standard and did not comply with the Adults with Incapacity legislation. The board's record-keeping was also of concern and we found that at times it fell below a reasonable standard and did not, amongst other things, record a reasonable standard of communication with Mrs C. We also found instances of statements in the board's complaints responses that were either inaccurate or misleading, indicating that Mrs C's complaint was not investigated as thoroughly as it should have been.

Recommendations

We recommended that the board:

• implement measures to avoid patients being given medication at the end of one medication round and the beginning of the next, thereby ensuring an appropriate period of time has elapsed between doses;
• implement checking mechanisms to ensure the prescription sheets are transcribed accurately;
• ensure patients authorised to be off-the-ward receive medication consistently as prescribed by medical staff;
• review the processes for managing, prescribing, administering and recording in relation to the flu vaccination;
• ensure that falls prevention procedures, including developing and evaluating falls prevention plans, are consistent with the board's policy;
• ensure effective systems are in place to keep staffing levels under review;
• take measures to ensure appropriate compliance with the Adults with Incapacity Act, with particular regard to DNAR decision making and communication with relative or carers;
• ensure that relatives' communication documentation is used consistently to record the nature and content of discussion with relatives or carers;
• build flexibility into the charge nurse's appointment system so that there are opportunities for communication outwith scheduled times to deal with issues as they arise;
• ensure that record-keeping reflects the care and medication given and a reasonable standard of communication;
• consider implementing unplanned visits to ensure a reasonable standard of hygiene;
• ensure complaints are investigated thoroughly and that responses are accurate; and
• apologise to Mrs C for all the failings identified in our investigation.

Summary

Miss C had been receiving a repeat prescription for tablets. However, on one occasion when she visited the pharmacy the pharmacist said the prescription could only be collected on certain dates, and that the next date had not yet arrived. Miss C had not been advised of this previously. The pharmacist gave Miss C five tablets to last until she could pick up her next prescription, although Miss C did not need that many tablets.

Miss C complained to us that the pharmacy applied rules about collection inconsistently and that although they had said there were dosage concerns, they then inconsistently issued more tablets than required. She was also unhappy with the way in which her complaint was handled.

We did not uphold Miss C's complaint about the inconsistent application of rules and issue of tablets. Our investigation found that the pharmacist was required to follow the advice of the prescribing doctor which in this case, was to provide a fortnight's supply of tablets every 14 days. The pattern of prescribing appears to have become slightly out of sync when the last prescription was written, leading to the change in dates. We did, however, make a recommendation to try to avoid this happening to someone else in future.

We upheld the complaint about complaints handling. Although the pharmacy acknowledged Miss C's complaint within their timescales, they did not respond to her until more than ten working days after receiving it, which was outside the recommended time limit. The pharmacy's head office, where the complaint was handled, is in England, and they failed to give Miss C information about the Scottish NHS complaints system and the Ombudsman.

Recommendations

We recommended that the pharmacy:

• provide staff with guidance that ensures that they clearly explain the prescribing regime to patients with repeat prescriptions, as well as indicating the dates on which patients can collect such prescriptions; and
• apologise to Miss C for failing to provide the correct information when responding to her complaint, and for the delay in responding.

Summary

Mr C complained about the board on behalf of his daughter (Miss A) who had been referred to the board's Child and Adolescent Mental Health Service (CAMHS) when she was 15. Mr C and his wife attended some of the consultations with her. Miss A was prescribed with fluoxetine (a medicine used to treat a variety of mental health problems) and subsequently discharged from the service.

Four years later, Miss A was diagnosed with bipolar disorder (a condition affecting a person's moods). Mr C considered that CAMHS should have diagnosed this when Miss A saw them four years earlier. He complained to us that that the assessment and treatment package provided by CAMHS did not meet his daughter's needs and that that they did not listen to him and his wife.

Our investigation included taking independent advice from one of our medical advisers. We upheld part of Mr C's complaint, as we found that the treatment provided to Miss A by CAMHS was reasonable, but that there were a number of deficiencies in the records. In particular, there was no record of the action taken by the psychiatrist who briefly saw Miss A and no record of any formal mental state examination. Staff also failed to explicitly state the diagnosis, treatment plan and prognosis. However, the records made at the time indicated that the clinicians had listened to and reported the concerns of Miss A's parents while she was being seen by CAMHS. There was no indication that Miss A showed any symptoms or signs that were specific to the diagnosis of bipolar mood disorder at that time and there was no reason to diagnose this. The only diagnosis that appeared to be applicable during that period of assessment was of a depressive disorder. Given this, bipolar mood disorder would have been a risk for the future, but one amongst a number.

Recommendations

We recommended that the board:

• issue a written apology for the deficiencies in Miss C's records; and
• review the record-keeping in CAMHS to try to ensure that such failures are no longer occurring.

Summary

Ms C was in the later stages of her first pregnancy, and was expecting twins. She went to hospital because she had vaginal bleeding. She was admitted for a consultant review and discharged home the following morning. Six days later she went into advanced labour and delivered both babies, but one of her twins died shortly after birth. Ms C complained to us about her care both before and after the birth.

Ms C's complaint had several elements, including inadequate care of a pre-eclampsia risk (a condition involving a combination of raised blood pressure and protein in the urine); inadequate care during two admissions which she said resulted in the premature birth of her twins and the death of her son; inadequate care and treatment for a post-natal haemorrhage (bleeding) and subsequent removal of products; poor record-keeping and delays in holding a clinical risk review (CRR).

Our investigation included taking independent advice from one of our medical advisers. We took account of this advice along with all the evidence provided by Ms C and the board, which included an internal report and two externally commissioned consultant reviews. Our investigation found no evidence of any failure that resulted in Ms C giving birth prematurely or any failure in care that resulted in the death of one of Ms C's twins. We also did not find any evidence of clinical failure with Ms C's post-natal care, but we did acknowledge that there were documentation failures and delays in holding the CRR.

Recommendations

We recommended that the board:

• ensure that the details of a speculum examination are fully documented to include the reasons if a cervix cannot be visualised and the rationale with regard to antenatal corticosteroids; and
• ensure the full documentation of all treatments delivered to patients is appropriately and timely recorded by those in attendance as soon as is feasibly possible, with specific reference to emergency situations.

Summary

Ms C complained that the care and treatment provided to her mother (Mrs A) was inadequate. Mrs A suffers from multiple sclerosis (MS) which is a degenerative disease affecting the nervous system. Sufferers can have various difficulties including mobility, digestive system and urinary problems.

In November 2010, Mrs A was hospitalised with a severe urinary infection which later developed into septicaemia (a serious bacterial infection). She was in several hospitals until early 2011. Ms C complained that, during her mother's time in hospital, the board failed to provide an adequate level of physiotherapy; failed to provide a reasonable level of specialist MS nursing care; failed to adequately communicate with the family, and failed to respond appropriately to Ms C's complaint.

Our investigation included taking independent advice from two medical advisers - a physician and nephrologist (kidney specialist) and a senior nurse with experience in neurological and neurosurgical nursing (treating illness or injury affecting the nervous system). We found that an appropriate level of physiotherapy and MS nursing input had been provided to Mrs A during her hospital stay.

Mrs A was, at times, very unwell and our medical advisers considered that the important thing was to address her acute symptoms of infection. When Mrs A was able to engage with the physiotherapy team, therapy was provided. Although the MS nurse only visited Mrs A once during her stay, the nursing adviser considered that there would have been no added value from further input at the time.

We found that Mrs A's MS was regularly and appropriately reviewed during her hospitalisation. However, the physician adviser felt that there was no evidence of communication between the doctors and Mrs A and her family. There were some records of communication from nursing staff but Ms C still felt that communication in general had been poor. The board had responded that next of kin are not automatically entitled to information about a patient and the patient's confidentiality had to be protected. However, our investigation found that guidance from the General Medical Council states that while patient confidentiality should be considered at all times, common sense should also prevail when a patient is very ill and unable to either give or withhold consent to share information with their family. In this case, Mrs A was at times very ill indeed and the advisers thought that staff should have used common sense in their communication with the family.

Ms C was also dissatisfied with the time taken to respond fully to her complaint and said that there were inaccuracies in the final letter from the chief executive. Our investigation confirmed that the timescales for responding to Ms C's complaint had been breached without her being kept up to date and that there were inaccuracies in the letter.

Recommendations

We recommended that the board:

• apologise for the failings in communication and complaint handling identified;
• make staff aware of and adhere to relevant guidance on communication with family/carers/loved ones; and
• make staff aware of and adhere to the guidance on complaints handling.

Summary

Mrs C complained on behalf of a village hall committee about Business Stream. She was unhappy with the water services the committee had been given. In particular, she said that their water meter had not been read for over a year, significantly increased consumption had not been brought to their attention and that Business Stream had failed to communicate adequately with the committee. She also alleged that Business Stream took a large amount of money from the committee's bank account by direct debit, without warning, when their water account was supposed to be on hold.

In investigating the complaint we took all relevant information into account, including statements of account, details of meter readings and customer correspondence etc. We did not, however, uphold most of Mrs C's complaints. We found that the meter had not been read between December 2009 and June 2011 although Business Stream had a statutory obligation to take a meter reading at least once a year. However, we found that after the December 2009 reading, a reading was intended to be taken in December 2010. This, however, was prevented by adverse weather conditions on the day, which were well documented, and so the meter was next read on 19 June 2011. In the circumstances, we did not consider this unreasonable. During the period when the meter was not read, estimated bills were issued. After the reading in June 2011 a bill was issued based on the reading, which reflected very high comparative usage. Although Mrs C argued that their use of water had not changed, neither the committee nor Business Stream could find a problem with the meter. Business Stream explored other possible explanations for the spike in usage but found nothing. They, therefore, concluded that the apparent increase in use reflected the catch-up required after the committee had been sent a number of estimated bills.

On balance, we concluded that this was a reasonable position to take. While Mrs C complained about the way in which Business Stream communicated with the committee, and said that one of their letters had gone unanswered, we found that they had not in fact received this letter. Otherwise, our investigation showed that all correspondence and phone calls were replied to. We found that Business Stream placed the committee's account on hold pending the outcome of the investigation into the complaint but, meanwhile, more than £2000 was taken from the committee's account by direct debit. Although Business Stream confirmed that the account had been placed on hold, they had not stopped requesting the direct debit. We took the view that this would be a customer's normal expectation in the circumstances and so we upheld this

Recommendations

We recommended that Business Stream Ltd:

• make a formal apology reinforced by a payment of £50; and
• seek to prevent such a situation recurring. Alternatively, they repay to the customer the amount of any direct debit taken under such circumstances as soon as the situation becomes known and while a complaint is still under investigation.